Medicare utilization rates in Boca

Medicare utilization rates in Boca Raton

Gina Kolata reports on Medicare utilization in Boca Raton, in this New York Times article from last Friday: "Patients in Florida Lining Up for All That Medicare Covers".

"BOCA RATON, Fla. — It is lunchtime, and the door to Boca Urology's office is locked. But outside, patients are milling about, calling the office on their cellphones, hoping the receptionist will let them in. To say they are eager hardly does them justice.

" "We never used to lock the door at lunch, but they came in an hour early," said Ellie Fertel, the office manager. "It's like they're waiting for a concert. Sometimes we forget to lock the door and they come in and sit in the dark."

"Yet few have serious medical problems, let alone emergencies. "It's the culture," said Dr. Jeffrey I. Miller, one of four urologists in the practice.

"Doctor visits have become a social activity in this place of palm trees and gated retirement communities. Many patients have 8, 10 or 12 specialists and visit one or more of them most days of the week. They bring their spouses and plan their days around their appointments, going out to eat or shopping while they are in the area. They know what they want; they choose specialists for every body part. And every visit, every procedure is covered by Medicare, the federal health insurance program for the elderly.

"Boca Raton, researchers agree, is a case study of what happens when people are given free rein to have all the medical care they could imagine..."

This is a serious story about the mechanism for setting Medicare reimbursements:

"... Medicare in Boca Raton pays $52.46 for a routine visit, in which a doctor sees a patient with no new problem. That is not enough, doctors say; it costs about $1,500 a day to run an office there, they explain. Payments in other states are different, adjusted for cost of living, but doctors say, and Mr. Scully agrees, that they are generally inadequate. Doctors who try to make a living seeing only Medicare patients for routine visits, he said, "have a very rough time."

"Medicare bases its payments on a system in which each kind of service is assigned a "relative value," Mr. Scully said. To increase the payment for routine office visits and stay within its budget, Medicare would have to decrease the relative value of other services.

"A committee of doctors meets each year to suggest relative values, he said, but "the most aggressive and active groups tend to be the specialists."

" "Year after year," Mr. Scully went on, "the specialists come in and make a very strong argument for higher reimbursements. There's eventually a squeeze on the basic office visit." "

The "culture" referred to in the opening quotes is in part an involuntary response to the odd price structure created by this system. General practitioners can't earn a living from extended office visits - they have to do lots of short ones, and pass patients on to specialists. The specialists can't make a living from office visits either; they make theirlivelihoodd off of tests and treatments. The culture apparently emerges as the patients find themselves spending a lot of time in doctors offices.

I learned about this from Virginia Postrel, here: "Entitlement Mentality".